To the Editor:

I am concerned about the AAFP's lack of action on the problem of independent nurse practitioners. With the ongoing destruction of the doctor-patient relationship by third-party payers and hospital-run IPAs, the push for nurse practitioners may well be a knock-out punch!

A nurse practitioner receives two extra years' training after college as opposed to our seven. If we are to believe that nurse practitioners have the same abilities as family physicians, we are allowing our profession to be mocked. Nurse practitioners can handle the minor routine problems of family practice, but I fear that, without a physician's supervision, they will not uncover the more subtle diagnoses.

What actions are being taken by the AAFP to protect the relationship between family physicians and their patients?

Response:

You are rightfully concerned about the burgeoning scope-of-practice issues facing family physicians all over the country and in various practice settings.

Over 80 percent of the AAFP's members are working with physician assistants, nurse practitioners or both. The AAFP supports the training of family physicians and nurse practitioners as teams. The end result of this extensive training and teamwork is truly comprehensive health care where patients are the winners.

However, the AAFP does not support independent practice for nurse practitioners. We have opposed broad expansion of scope of practice for these professionals on both the state and federal levels, precisely for reasons you have cited — nurse practitioner training does not prepare them for the diagnostic challenges of the “undifferentiated” patient.

It has been the AAFP's contention that using nurse practitioners as the first point of contact with previously undiagnosed patients is actually more expensive due to their extensive use of subspecialty referrals. Making the appropriate diagnosis at the first point of contact means better patient care, causes less hassle for the patient and makes better fiscal sense.

In addition to working legislatively on the state and federal levels to influence scope-of-practice issues, we have been very vocal in our opposition to independent practice by nurse practitioners through a number of national news programs and articles, including 60 Minutes, Newsweek and People. And we will continue to make sure our voices are heard.

Editor's note: This letter is a response to “Nurse Practitioners: Growing Competition for Family Physicians?” in our October 1998 issue.